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35-305 (2) MUNICIPAL WATER AVAILABILITY APPLICATION Northampton Water Department 237 Prospect St. Northampton,MA 01060 587-1097 A Department of Public Works Trench Permit shall be required prior to any construction or connection activity associated with this application. Location: 1015 Ryan Road, Florence,MA Inquiry Made By: Ted Towne, 23 Loudville Road, Easthampton,MA 01027 246-6841 Date of Inquiry: 6/9/09 Property will contain Two multi family homes. Number of 2 Type of Single Family Type of Private Units: Unit(s): Accessory Apart. Ownership: Condo Multi-family Rental (Annlicant to fill out the above) Municipal Water Main in Existing service to Front of Location? Yes: X No: site? Yes: X No Size of Water Main: 8" Material: C.I. Age: 1945 Approximate Static Street Flow Test Conducted: Yes: No: X Pressure: 48 psi If done attach results Size of Service Connection 3/4"Existing - 1" Suggested Suggested Meter Size: 5/8 Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. Each house shall have separate service&meter. Water Dept cannot guarantee adequate pressure and volume with existing service. • A corresponding water entrance fee shall be paid prior to making any connection to the municipal water system. • Arrangements of such installation shall be made with the Northampton Water Department ' 'mum of 5 working days notification. • All work shall conform to Northampton Water Department ifications. Each building shall have individual service lines from street.- / � David W. Sparks, Superintendent of Water Water Entry$ 200. Meter$ 200 Radio 9x00. cc: Ned Huntley, Director cc: Tony Patillo, Building Inspector Note: If this availability is for a new construction,it must be hand delivered to the Building Inspector. MUNICIPAL WATER AVAILABILITY APPLICATION Northampton Water Department 237 Prospect St. Northampton,MA 01060 587-1097 A Department of Public Works Trench Permit shall be required prior to any construction or connection activity associated with this application. Location: 1015 Ryan Road, Florence,MA Inquiry Made By: Ted Towne, 23 Loudville Road,Easthampton,MA 01027 246-6841 Date of Inquiry: 6/9/09 Property will contain Two multi family homes. Number of 2 Type of Single Family Type of Private Units: Unit(s): Accessory Apart. Ownership: Condo Multi-family Rental (Aunlicant to fill opt the above) Municipal Water Main in Existing service to Front of Location? Yes:X No: site? Yes: X No .. Size of Water Main: 8" Material: C.I. Age: 1945 Approximate Static Street Flow Test Conducted: Yes: No: X Pressure: 48 psi If done attach results Size of Service Connection 3/4"Existing - 1" Suggested Suggested Meter Size: 5/8" Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. Each house shall have separate service&meter. Water Dept cannot guarantee adequate pressure and volume with existing service. • A corresponding water entrance fee shall be paid prior to making any connection to the municipal water system. • Arrangements of such installation shall be made with the Northampton Water Department ' ' 'mum of 5 working days notification. • All work shall conform to Northampton Water Department rfications. Each building shall have individual service lines from street.- / / David W. Sparks, Superintendent of Water Water Entry$ 200. Meter$ 200" 5x00. cc: Ned Huntley,Director cc: Tony Patillo, Building Inspector Note: If this availability is for a new construction,it must be hand delivered to the Building Inspector. MUNICIPAL SEWER/AVAILABILITY APPLICATION Northampton Streets Department 125 Locust Street Northampton, MA 01060 587-1570 A Department of Public Works Trench Permit and Sewer Entry Permit shall be required prior to any construction or connection activity associated with this application. Location: 1015 Ryan Road, Florence Inquiry Made By: Wayne Feiden, Planning & Development 587-1072 ( Eric ) Date of Inquiry: 8/7/08 Property will contairl i Single-Family Homes Reason for See Attached Letter from Planning Request: Municipal Sewer Main in Front of Location: Yes _ No Municipal Storm Drain Available: 5 t/2 deep Yes No Size of Sewer Main: °r Material: Age: r � Depth of Sewer Main: Size of Service Connection: `( C Type of Service Connection: Tie-in to Sanitary Main Comments: RYA A/ ) SLv i�V6 16 e Am 1r 66 Note: If this availibility is for new construction this form must be hand delivered to Building Inspector. A corresponding"sewer entrance fee"shall be paid priorto making any connection to the municipal sewer system.Arrangements of such installation shall be made with the Northampton Streets Departmentwith a minimum of 5 working days notification. All work shall conform to Northampton Streets Department specifications. John Hall Sewer Department cc: Ned Huntley, Director DPW Anthony Patillo, Building Inspector Llifio of N. ttzzhamptort F u ; $ - � �Iassat4�nsetfs i�l " DEPARTMENT Or BUILDIT;G INSPECTIONS � 212 Main Street o Muuicipal Buildin, INSPECTOR Northampton,MA 01060 LOCATION � �� J -Two lmpvcM5 SQUARE FOOTAGE AMOUNT BASEMENT @ :20 Lt 171P 1sT FLOOR @.50 C) L1 2"FLR @:30 - /FLOORS, FINISH ATTIC,GARAGE @.20 DECK/PORCHES @ .20 TOTAL ffd,7_7_ yy FT puz- f � 31 co ' � Lw J Permit No. D18-09 Conditions: Driveway Permit In lieu of plan approved by the City Engineer I agree to the following added conditions: 1. I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2. I further agree that if in the inspections, any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. 3. fieoyoos-ep v.Q�vEui• �/.hS f'ay.� l��c>�ST�9T�.t'�z'TLI.t�� Ts 4111 By Petitioner Signature Gtr1G� 0.'/ iQ /0Or! Name: Theodore Towne 4!�V Address: 23 Loudville Road, Easthampton 6/9/,01 413-246-6841 Note: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. For Commercial and Industrial applicants, a plan showing the proposed driveway with grades and location is required. Cc: Building Inspector Permit No. .D18-09 CITY OF NORTHAMPTON, MA DRIVEWAY PERMIT Date: 5/28/09 Check 9: 3302 FEE: $250.00 THE BOARD OF PUBLIC WORKS Driveway must be staked and house & lot number posted The undersigned respectfully petitions your honorable body for: A new driveway Permission to install a driveway at: 1015 Ryan Road Fifteen (15) foot maximum width at the street line. Gutter drainage not to be disturbed. All Drainage shall be directed off the driveway surface to adjacent land and not on the existing Roadway. Driveway surface to be paved as soon as possible if the grade of the proposed Driveway exceeds 3% or more. Homeowners will be held responsible for any cost to the City Of Northampton in the event of a washout of this driveway. By: Theodore Towne Telephone: 413-246-6841 Signature:Proposed Location Location Inspection By: /F,/ � Gravel Base Grade Inspected By: Final Approval: THE BOARD OF PUBLIC WORKS voted that petition be granted. Edward S. Huntley, P.E. Director of Public Works Cc: Building Inspector (SUBJECT TO ATTACHED CONDITION 1 & 2)c212W ea,jd 1rj4 ,3 � 007 All joints,seams,and connections are made substantially airtight with tapes,gasketing,mastics(adhesives)or other approved closure systems.Tapes and mastics are rated UL 181A or UL 181 B. Building framing cavities are not used as supply ducts. Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Additional requirements for tape seating and metal duct pimping are included by an inspection for compliance with the International Mechanical Code. Temperature Controls: 0 Thermostats exist for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor is provided. Heating and Cooling Equipment Sizing: © Additional requirements for equipment sizing are included by an inspection for compliance with the international Mechanical Code. Circulating Hot Water Systems: L] Circulating hot water pipes are insulated to R-2. L] Circulating hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: Cj HVAC piping purveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-2. Certificate: 0 A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment. NOTES TO FIELD:(Building Department Use Only) Project Title. Ryan Road Dupiesex Report date:06/08/09 Data filename:C:1Documents and SettingslEvelyntMy DocumentslMy Pict mVeschedc.rdc Page 3 of 3 i;2EScheck Software Version 4.1.3 f*44" Inspection Checklist Date:1)6 OW% Ceilings: Ceiling:Fiat or Scissor Truss,R-48.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall:Wood Frame,16in.o.c.,R-32.0 cavity insulation Continents: ❑ Wall:Wood Frame,16in.o.c.,R-19.0 cavity insulation Comments: ❑ Wall:Wood Frame,16in.o.c.,R-19.0 cavity insulation Comments, Q Wail:Wood Frame,16in.o.c.,R-19.0 cavity insulation Comments: Floors: ❑ Floor-Ail-Wood Joist/Truss Over Uncond.Space,R-19.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Heating and Cooling Equipment: D Boiler 1::90 AFUE or higher Make and Model Number: Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed. D Recessed fights are either 1)Type IC rated with enclosures sealed/gasketed against leaks to the ceiling,or 2)Type IC rated and ASTM E283 labeled,or 3)installed inside an air-tight assembly with a 0.5"clearance from combustible materials and a 3"clearance from insulation. Vapor Retarder. D Vapor retarder is installed on the warm-in-winter side of all non-vented framed ceilings,wafts,and floors;or it has been determined that moisture or its freezing will not damage the materials;or other approved means to avoid condensation are provided. Comments: Materials Identification: D Materials and equipment are identified so that compliance can be deteruned. D Manufacturer manuals for all installed heating and coding equipment and service water heating equipment have been provided. ❑ Insulation R-values,glazing U-factors,and heating equipment efficiency are dearly marked on the building plans or specifications. D Insulation is installed according to manufacturers instructions,in substantial contact with the surface being insulated,and in a manner that achieves the rated R-value without compressing the vululation. Duct Insulation: D Duda in unconditioned spaces or outside the buildng are insulated to at least R-8. D Duds in floor trusses above unconditioned spaces or above the outdoors are insulated to at least R-6. Duct Construction: u Air handlers,filter boxes,and dud connections Ica flanges of air distribution system equipment or sheet metal fittings are sealed and medtarticeNy fastened. Project Title:Ryan Road Duplesex •Report date:06/08/09 Data filename:C.0ocumerrts and Settings\Evelyn\My Documents\My Pidures\rescheck.rdc Page 2 of 3 M-M . _ _ G Ceiling/Roof 48.00 Wall 32.00 Floor f Foundation 19.00 Ductwork(unconditioned spaces): Window Door Boiler 90 AFUE Water Heater. Name: Date: Comments: REScheck Software Version 4.1.3 Compliance Certificate Project Title: Ryan Road DUpiesea Report Date:06/08/09 Data filename:C:\Documents and Settings\Evelyn\My Documents\Mv Pic turesMescheck rck Energy Code: 20061ECG Location: Northampton,Massachusetts Construction Type: Single Family Builidng Orientation: Bldg.faces 180 deg.from North Conditioned Floor Area: 600 ft2 Glazing Area Percentage: 0% Heating Degree Days: 6404 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor. 1015 Ryan Rd Alabama Alabama Florence,Massachusetts 01062 n. z '� " "�w ;. AM, Compliance:0.0%Better Than Cade Maximum UA:134 Your UA:134 Gross Cavity Cont. Glazing ILIA Assembly Area or R-Value R-Value or D.. Perimeter U-Factor Ceiling:Flat or Scissor Truss 600 48.0 0.0 16 Wall:Wood Frame,16in.o.c. 480 32.0 0.0 23 Orientation:Right Side Wall:Wood Frame,161n.o.c. 320 19.0 0.0 19 Orientation:Back Wall:Wood Frame,16in.o.c. 480 19.0 0.0 29 Orientation:Left Side Wail:Wood Frame,161n.o.c. 320 19.0 0.0 19 Orientation:Front Floor:All-Wood Joist/Truss Over Uncond.Space 600 19.0 0.0 28 Boiler 1:90 AFUE Compliance Statement The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2006 IECC requirements in REScheck Version 4.1.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title:Ryan Road Duplesex 'Report date:06/08/09 Data filename:C:\Documents and Settings\Evelyn\My Documents\My Pictureskescheek.rck Page 1 of 3 Board of Building Regulations and Standards Construction Supervisor License � - License: CS 722 Birthdate: 82011962 s Expiration. 8/2012009 Tr# 2488 w. Restriction: 00 THEODORE D TOVdUE JR 21 LOUDVILLE RD EASTHAMPTON,MA 01027 Commissioner Board of Bu'ildinb Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only / Registration before the expiration date. If found return to: / : 132751 Board of Building Regulations and Standards Expiration: 412/2011 Tr# 283518 One Ashburton Place Rm 1301 Type: Individual Boston,Ms.02108 THEODORE TOWNE JR. THEODORE TOWNE 21 LOUDVILLE RD. EASTHAMPTON,MA 01027' Administrator Not valid without signature m �'ACDAQ DATE{fADt+DO/YY1 Yf CERTIFICATE OF LIABILITY INSURANCE 10/26/2007 PRODUCER (413)586-0111 FAX (413)S&6-6481 THIS CERTIFICATE IS ISSUED AS A NATTER OF INFORMATION Webber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOET 8 North King Street TER THE COVERAGE AFFORDED BY THE POLICIES EXTEND BELOW. Northampton, MA 01060 INSURERS AFFORDING COVERAGE NAIC# _ m Theo re Tame, Jr. A: NGN Insurance Company 14788 21 Loudvi l l a Road INSURERS- WCAR Conti nental/CNA Easthampton, MA 01027 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAND ABOVE FOR THE POLICY PERIOD 04DICATED_NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II�R TYPE OF"IstIRANCE POLICY"UMBER 4KWJCY ISFCTIVE POLICY EXPIRATION -- LIMITS GEMERALLIAeMJTY WIS1046 06/29/2007 06/29/2008 EACxIO� $ 1,000,001 PCO' ERCIAL GENERAL LIABILITY Soo,0� CLAM MADE MX OCCUR MED EW(AMY aye ) $ 10,00+ A PERSONAL a AM INJURY $ 1,000,004 GENERAL AGGREGATE $ 21000,004 GEN'L AGGREGATE LIMIT APPLIES PER: PROOU=-COMHOP AGG S 2,000,00 POLICY M 2clor LOC AUTOMOBILE LUU38- Y COIAWED LIMIT $ ANY AUTO . ALL OWNED AUTOS BODILY INJURY (P-P—) $ SCHEDULED AUTOS HIRED AUTOS SORRY INJURY NON-OWNED AUTOS (Per ate) $ (P DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S R ANY AM OTHER THAN EA ACC $ AUTO ONLY: AGG 5 EXCESSAJUBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FI CLASIS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S $ VVOjU9MCOMP0ISATIONAM 6SS9U87S82A60207 07/07/2007 07/07/2008 wc STATu- TORY111111ITS1 101TV 13 WLOYBW UABLM E.L.EACH ACCIDENT $ 100,00 6 ANY PROPRIETORIPARTNBRMECUTIVE EX E I DISEASE-EA ELVLOYEE $ 100,00 vPEpAL-M0 ONS b.W,. E.L.DISEASE-POLICY LIMIT S S00 001 OTHER DESCM I N OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY EMDOPZEWMT I SPECIAL PROVISIONS CERTIFICATE HOLD R CA CELLATION $Hot O ANY OF THE ABOVE DESCRW®POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MALI. DAYS WRITTEN NOTICE TO TIC CEKnRCATE HOLDER NAMED TO THE LEFT. BUT FmAw TO MALL SUCN NOTICE SHALL WAKM NO OBLIGATION OR UABIL.TTY �. OF ANY KW UPON THE DISURFR.ITS AGEM OR REPRESENTATIVES. ------- For Information Only ------- ALRHOROW REPRESELCrAMW 13enna Rodri ue CISR CINDY w ACORD 25(2001/0x) MACORD CORPORATION 198 CERTIFICATE OF LIABILITY INSURANCE DATE 06/02/2009 ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Aon Risk Services Central, Inc. southfi el d MI Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 300 Town Center CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE suite 3000 COVERAGE AFFORDED BY THE POLICIES BELOW. Southfield MI 48075 USA INSURERS AFFORDING COVERAGE NAIC# PHONE- 866 283-7122 FAX- 847 953-5390 INSURED INSURER A: Travelers Property Cas Co of America 25674 •• i Builder services Group, Inc. INSURERS: Travelers Indemnity Co of America 25666 d/b/a Collins & Company G A Masco Corporation Company INSURER C: old Republic Ins Co 24147 ou 48 Hockanum Boulevard �. Vernon CT 06066 USA [INSURER D: URER E: O COVERAGES SIR applies per terms and conditions of the policy THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LIMITS SHOWN ARE AS REQUESTED INSR D LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMJDD DA. M/DD c LLIABILITY MWZY5552508 06/30/2008 06/30/2009 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $2,000,000 PREMISES(Fa occurrence CLAIMS MADE ® OCCUR ove Deaov $25,00 N PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $5,000,000 'r-O GENL AGGREGATE I MIT APPLIES PER PRODUCTS-COMPIOP AGG $10,000,000 p ❑X POLICY ❑ PRO- LOC JECT an c AUrOMOBn.ELIABILITY MWTB 18398 08 06/30/2008 06/30/2009 coltmtNm SINGLE LIlWT a ANY AUTO (Fa accident) $5,000,000 Z v ALL OWNED AUTOS BODILY INJURY v SCHEDULED AUTOS (Per Penton) HIRED AUTOS ~ BODILY INJURY (� NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accidaa) GARAGE LIABILrTY AUTO ONLY-EA ACCIDENT H ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG EXCESS/UMBRELLA LL4SHX Y EACH OCCURRENCE ❑OCCUR Q CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION A TC JUB - TIL- X C STATU OTH- WORKERS COMPENSATION AND y� Deductible - AOS 6 EMPLOYERS LIABILITY 1 TCZHUB121DI27-4-TIL-08 06/30/2008 06/30/2009 EL,EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER./EXECUTIVE 1_1 Deductible - Minnesota OFFICER/MEMBER EXCLUDED? EL,DISEASE-EA EMPLOYEE $1,000,000 A (Mandatary,in NR) TRIUB122DO26AO8 06/30/2008 06/30/2009 If mdescr ikvunderSPECIALPROVISIONSbeiow Retro - AZ,HI,MA,OR,WI E.LDiSEASE-POLJCYL[MfT $1,000,000 A TWX7UB122DO27-1-TIL-08 06/30/2008 Retention $2,000,000 OTTER Self-Insured States statutory included Excess We DESCRJPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIGNS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ■ CERTIFICATE HOLDER CANCELLATION Theodore Towne SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANrPt I F^BEFORE THE EXPIRATION 75 Parson street Apt. V DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL - Easthampton MA 01027 USA B°FAILUURET�ODOSOSSHALLTiM SE NOOBLIGA to ORLLIABIILITTY� - OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) (01988-2009 ACORD CORPORATION.All rights reserved= The ACORD name and logo are registered marls of ACORD , ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 0610112009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION K.S.K.INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 203 Northampton St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. Box 597 INSURERS AFFORDING COVERAGE Easthampton MA 01027 INSURED INSURER A: HOLYOKE MUTUAL INSURANCE COMPANY M&R CONCRETE INSURER B. SAFETY INSURANCE COMPANY P.0 BOX 688 INSURER C: EASTHAMPTON,MA 01027 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $1,000,000. A COMMERCIAL GENERAL LIABILITY CPP0007016949 06103109 06/03/10 FIRE DAMAGE An one fire $50,0_0_0. CLAIMS MADE Fx_x1 OCCUR MED EXP(Any one person) $5,000. PERSONAL&ADV INJURY $1,000,000. GENERAL AGGREGATE $2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000. T POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 3116413 03124/2009 0312412010 (Ea accident) $1,000,000. ALL OWNED AUTOS BODILY INJURY $ X SCHEDULEDAUTOS (Perpe.) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR EI CLAIMS MADE AGGREGATE $_ -- $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATIT FR EMPLOYERS'LIABILITY BEING REQUESTED E.L.EACH ACCIDENT Is E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Concrete Construction CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION TOWNE BUILDERS SHOULDANYOFTHE ABOVE DESCRIBED POLICIES BECANCELLED BEFORETHE EXPIRATION 75 PARSONS ST APT V DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN EASTHAMPTON, MA 01027 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S(7/97) -5 ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID JR DATE(MWDDA'YYY) XTOWNEP 06/01/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE First American Insurance Agy. , HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 510 Front Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chicopee MA 01013 Phone: 413-592-8118 Fax:413-592-0995 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Patrons Mutual Insurance INSURER B: Timothy Towne dba Towne Painting INSURER C: 139 Edwards Road INSURER D: Westhampton MA 01027 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY UK A001 F E P U Y ATI N rA NSR TYPE OF INSURANCE POLICY NUMBER DATE MMfD DIYY DATE MMID D LIMITS GENERAL LIABILITY EACH OCCURRENCE $10_0_0000 X COMMERCIAL GENERAL LIABILITY CTR0010310 04/28/09 04/28/10 PREMISES(Ea occurence) $50000 CLAIMS MADE D x OCCUR "ED EX.P(Any one person) $5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE s2000000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2 000000 POLICY PRO JE O- 71 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ I ANY AUTO (Ea accident) ALL OWNED AUTOS i i BODILY INJURY $ SCHEDULED AUTOS (Per person) i HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESWUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ 1 $ ]DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Tonwe Builders IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 75 Parsons Street, Apt V REPRESENTATIVES, Easthampton MA 01027 AUTOO DREPRESENTATNE ACORD 25(2001108) ©ACORD CORPORATION 1988 ACOBA CERTIFICATE OF LIABILITY INSURANCE 06/0/2o 0 PRODUCER )527-5520 FAX (413)S27-S970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fi nc & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 Campus Lane HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 Rebecca Kubosiak INSURERS AFFORDING COVERAGE NAIC# INSURED Shea Tree Service, Inc. INSURERA: Western World P.O. Box 367 INSURER B: Commerce Insurance Company 347S4 Easthampton, MA 01027 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IYL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS rn_Dj GENERAL LIABILITY NPP1195SO4 09/26/2008 09/26/2009 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,00 A PERSONAL&ADV INJURY $ 1,000,0001 GENERAL AGGREGATE $ 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JPERC LOC AUTOMOBILE LIABILITY RPTSO4 02/20/2009 02/20/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ 2008 International PROPERTY DAMAGE X E $ Bucket Truck (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC $ _ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE $ $ ]DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH ER, — EMPLOYERS'LIABILITY E.L.EACH $ ANY PROPRIETOFVPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS HOLDER CERTIFICATE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Towne Builders BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 75 Parsons St. Apt. V OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Easthampton, MA 01027 AUTHORIZED REPRESENTATIVE [Rebecca Kubosiak BECKY T�It ACORD 25(2001108) ©ACORD CORPORATION 1988 ACCR a,� CERTIFICATE OF LIABILITY INSURANCE 06/01/2 0' PRODUCER (413)527-5520 FAX (413)527-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 Campus Lane HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 INSURERS AFFORDING COVERAGE NAIC# INSURED Bill Willard, Inc INSURERA: General Casualty 24414 1010 Ryan Road INSURER B: Florence, MA 01062 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR kD17L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MMODfM GENERAL LIABILITY CCIO393622 08/01/2008 08/01/2009 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,0001 CLAIMS MADE I OCCUR MED EXP(Any one person) $ S'0001 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY PC-CT LOC AUTOMOBILE LIABILITY CBA0393622 08/01/2008 08/01/2009 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per pew) $ A 1,000,000 X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY CCU0393622 08/01/2008 08/01/2009 EACH OCCURRENCE $ S'000,000 X OCCUR F]CLAIMS MADE AGGREGATE $ S'000,000 A S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERSLIABILITY EL EACH.ACCiDENT.. ANY PROPRIETORIPARTNERIEXECUTNE - - OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 11 yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Ted Towne Builders BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 75 Carson Street; Apt V OF A KIN UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. Easthampton, MA 01027 AUTH NTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 MAY-18-2009 PION 10:24 AM FAX N0. P. 01/01 �ACOM CERTIFICATE OF LIABILITY INSURANCE ostl;` x a ROOUCES 413 586-0111 FAX (413)686--6481 THIS CERTFICATE IS ISSUED AS A MATTER OF OIFORMATION tebber i Grinnell Ins. Agency, Inc. ONLY AND CONFER$NO FWWM UPON THE CERTIFICATE i North King Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTENNDE OR MM IM COVERAGE AFQM BY THE NortbaEpton, PA OiO6O INSURERS AFFORDING COVERAGE NAIC IM mum The6&re IsiAi, 1r. WGURERA: NM Insurance C01#pin 14788 21 Loudvil le Road r►6IAR E: WM- Savers Propert ua Cas t Easthampton. MA 01027 N3UftR C: INSURER 0: mum R: MEMO THE PO IM OF*ISURANCE LISTED BELOW 141VF SEEN MUED TO THE INSURE?NAMED ABOVE FOR THE POLICY PERIOD MCATEO.NOTWTHSTANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WH"THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE 111 IRAMCE AFFORDED BY THE POLICIES DESCRI LEO HEREDIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POUCM AGGREGATE LOATS SHOWN MAY HAVE BEEN REDUCED 6Y PAID CLAIMS. TYPE OF IM URAMCE POLICY Mmom fArn'i Op"PALUAGLay MPI51040 06/29/2006 06/29/2009 MROCCURRBNCE $ 1 O00 X COMMERCIAL GENEM LIABLr" i 500 CLAIMS WM ff]OCCUR m"EXP wo am perwrl i 10 A PERSON4 a AOV E"Ay f 1 000 GeWPALAGGRIMTif s 2.000 OWL AGGREGAULAINTAPPLUMPIK* PRODUCTS-COMPIOPAW i j POLICY M JECT Luc AITONCOU LIABILITY C NK:LE LikaT UTO - ANY A s ALLOWNWALffOS GO pYonlN"m sc"mu"D AUme _ HIREO AUTOS RODILYWAIRY L NON-OWNED AUTOS PROPERTY DAMAGE _ (Per exdwnl? OARAWMAO M AUfO0NLY-EAACC9WAT i ANY AUTO OTHER THAN 6A ACC i �^ AUTO ONLY.• AOG �!LYIELRY eACH OCCURRENCE i OCCUR CLAIMS MADE ASMOATE i i OFDUCTMLE i RETEfmm i i WORKERS CONIPPROATTONANO AN426011 07 7/2008 07/0712009 X RAPLOYERIF UASKM &.L.EACH ACL IDW I 100.0 ANY 4n4 e El.QtSEJLBE•BAlgYPlOY' ; 100 wL IOffs Ova„ S.L.OIKA$e-POLICY LeNIT s 500. DYNRR DESCRIPTION OF OPERAMONS I LOCATIONS/YP.IOC AG I MOUNIONS AODEO BY Er1OrN*06MENr1 SPECIILL MUNISI ML SHOULD ANY OF THE ABOE DEEC OGO POU9166 ND CANCELLED sEPOKE nM EXPIRATION OAT&TNERIOP,TIE OWING NISURER WILL ENDEAVOR TO ELAN. .-AO DAYS ONFr M NOTICE TO YNI CERTtP1CAT9 HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL VAM NOTION 6NALL MAtOW NO OELICATON OR LAELnY :...:' OF ANY KIND UPON THE INSU ITs A MM OR ROM MTATMOL Evidence of Insurance AOTIIORI NORNP011SEILTATM 7enna Rodri as ]ER ACORD Z5(n0jM) FAX. (411)527-%45 OACORD CORPORATION 19N HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing&gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of Massachusetts .� ZZZ Department of Industrial Accidents ', Office of Investigations _ 600 ff'ashinao-ton Street ri Boston,MA 02111 k www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: iti&14� A City/State/Zip: • e7 r& Z2 Phone#: _Z_o�7 —C)�4 5� Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. X I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' 9. Buildino addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers comp. right of exemption per MGL Y � ' P 12.0 Roof repairs . insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: �- Policy#or Self-ins.Lic.#: 0 act> Expiration Date: Job Site Address: I U J A, `� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 7, //2� Date: , Phone#: S,�L7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ((ll Not Applicable ❑ Name of License Holder: � -z l tl f //L ' License Number az,) 9. Address Expiration DAte—� Signature Telephone 9. Registered-Home.lmproveri Lina(Contractor.;;;,, Not Applicable ❑ Company Name c Registration Number q/a/ /1 Address Expiration D to Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.''152,§25C(6))'' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ 11. iIome Owner:Ege " ion The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [7-71 Addition ❑ Replacement Windows Alteration(s) El Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding[0] Other[0] Brief Description of Proposed Work: �a ��fi � � W Pte'!1✓l C Alteration of existing bedroom Yes NN Adding new bedroom Yes J Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or.addition to existing housing, complete the following: a. Use of building : One Family Two Family X Other b. Number of rooms in each family unit: Number of Bathrooms 0 c. Is there a garage attached? 2, f r' d. Proposed Square footage of new construction. `f U 0 ,,dgAg Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each -� g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes _ _No. Is construction within 100 yr. floodplain Yes_X No j. Depth of basement or cellar floor below finished grade 6 � ti k. Will building conform to the Building and Zoning regulations? _A Yes No. I. Septic Tank City Sewer�_ Private well City water Supply _ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, � �} as Owner/Authorized Agent hereby declare that the statement and informVFn on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signatdre`of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size C ;t5 4'-0 Frontage c/O.7d' _.._ .....___.. _..... _ . _-. Setbacks Front Side L:" . R. L R ...a.a.' Rear Building Height µ �"? Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: y - -- (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/'on the site? NO 0 DONT KNOW YES IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW rv^YES 0 IF YES: enter Book Page' and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Statusaff'em,if p Building Department Curb Cut/Dmreway Permit 212 Main Street Sewer/S" ive)va 66mty Room 100 Water/ilUell Avaiiabiirt ` Northampton, MA 01060 Two Se#s of Struhirat Plans phone 413-587-1240 Fax 413-587-1272 PIat/StePlans Over Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION This section to be completed by office 1.1 Property Address: Map J' Lot 10 5 Unit Szone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSWPtAD7THORIZED AGENT 2.1 Owner of Record: :T:1-1 e 0 U' U Name(Print) Current Mailing A'ddre s:'j Gam/ �t7ra'Zi*-rt� Telephone Signature % r-.2 k 4 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone 4G„2 `j 5� SECTION 3-ESTIMATED CONSTRUCTION COSTS Item 'r Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 4 G c0 (a)Building Permit Fee � 2. Electrical (b)Estimated Total Cost of '- Construction-from 6 3. Plumbing Building Permit Fee LI 4. Mechanical(HVAC) 5. Fire Protection b U 6. Total=(1 +2+3+4+5) �. p r9 CJ Check Number This Section For Official Use_Onl Date Building Permit Number Issued` Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-1039 APPLICANT/CONTACT PERSON THEODORE D TOWNE ADDRESS/PHONE 75 PARSONS ST APT V EASTHAMPTON (413)527-9060 PROPERTY LOCATION RYAN RD-#2 MAP 35 PARCEL 305 001 ZONE SR/WSPII THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid J Typeof Construction: CONSTRUCT 2 STORY 2 FAMILY HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildiniz Plans Included: Owner/Statement or License 000722 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFtMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 0 6 �- Signa Building O is al Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. t . ; BP-2009-1039 GIs#: COMMONWEALTH OF MASSACHUSETTS Ap; bck: 5- t�== CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2009-1039 Project# JS-2009-001498 Est. Cost: $120000.00 Fee: $1200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: 5B Contractor: License: Use Group: R4 THEODORE D TOWNE 000722 Lot Size(sg. 1): 35538.00 Owner: TOWNE THEODORE&EVELYN M Zoning: SR/WSPII Applicant: THEODORE D TOWNE AT. 1015 RYAN RD - #2 Applicant Address: Phone: Insurance: 75 PARSONS ST APT V (413) 527-9060 WC EASTHAMPTONMA01027 ISSUED ON:71112009 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2 STORY 2 FAMILY HOUSE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 7/1/2009 0:00:00 $1200.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo